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Iodine Consumption and Hashimoto's Thyroiditis: a Systematic Literature

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Iodine Consumption and Hashimoto's Thyroiditis: a Systematic Literature THESIS CALIFORNIASTATE UNIVERSITY SAN MARCOS THESIS SUBMITTED IN PARTIAL FULFILLMENTOF THE REQUIREMENTSFOR THE DEGREE :tv1ASTER OF PUBLIC HEAL TH TITLE: Hashimoto's Thyroiditis and Iodine Consumption AUTHOR(S): Sandra Cracchiolo DATE OF SUCCESSFUL DEFENSE: 04/23/2020 THE THESIS HAS BEEN ACCEPTED BY THE THESIS COMMITTEE IN PARTIAL FULFILLMENTOF THE REQUIREMENTS FOR THE DEGREE OF :tv1ASTER OF PUBLIC HEAL TH Asherlev Santos May 4, 2020 COMMITTEECHAIR SIGNATURE DATE Kathryn Hollenbach May 4, 2020 COMMITTEE MEMBER SIGNATURE DATE COMMITTEE MEMBER SIGNATURE DATE COMMITTEE MEMBER SIGNATURE DATE Iodine Consumption and Hashimoto’s Thyroiditis: A Systematic Literature Review Sandra Cracchiolo California State University San Marcos IODINE AND HASHIMOTO’S THYROIDITIS 2 Abstract Iodine deficiency is a global health problem that is affecting over 2 billion people worldwide and 50 million people are dealing with the health issues directly related to being iodine deficient. The Universal Salt Iodization policy was created as a global initiative to eliminate iodine deficiency disorders worldwide and was implemented on a mandatory or voluntary basis. Hashimoto’s thyroiditis is an autoimmune disease that attacks healthy thyroid cells by an antibody-mediated immune response. This disease affects 1.5 per 1000 worldwide and that number is continuing to increase. This systematic literature review examined previous studies to determine if an association exists between the prevalence of Hashimoto’s thyroiditis in relation to the levels of iodine consumption after universal salt iodization. Keywords: Iodine, autoimmune thyroiditis, autoimmune disease, antibodies, Hashimoto’s thyroiditis, Universal Salt Iodization policy IODINE AND HASHIMOTO’S THYROIDITIS 3 Acknowledgements I would like to thank my committee for their continuous support throughout the development of my thesis. Thank you to my chair, Dr. Santos for always pushing me to dive deeper into my research. Thank you to Dr. Hollenbach for being my mentor, throughout this process as well in the professional world. Being able to work with you has taught me a great deal about what I want to further my career in, and I am truly grateful. To my sister; my best friend; thank you for being there always, keeping my sane throughout this entire process, and being my proofreader. La mia tesi è dedicata alla mia famiglia, che ha lasciato tutto per venire in questo paese, per poter avere una vita migliore. Soprattutto a mia Nonna che mi ha insegnato a inseguire sempre i miei sogni senza arrendermi mai. IODINE AND HASHIMOTO’S THYROIDITIS 4 List of Tables Table 1. Studies with various iodine levels and Hashimoto’s thyroiditis Table 2. Studies with iodine fortification and rates of Hashimoto’s thyroiditis Table 3. Universal Salt Iodization Policy and Iodine Deficiency IODINE AND HASHIMOTO’S THYROIDITIS 5 List of Figures Figure 1. Recommended Dietary Allowance (RDA) for Iodine Figure 2. Global Scorecard for Iodine Nutrition 2019 Figure 3. Flowchart for the first initial search in Systematic Literature Review Figure 4. Flowchart for the second initial search in Systematic Literature Review IODINE AND HASHIMOTO’S THYROIDITIS 6 Table of Contents Abstract ....................................................................................................................................... 2 Acknowledgements ..................................................................................................................... 3 List of Tables .............................................................................................................................. 4 List of Figures ............................................................................................................................. 5 Introduction ................................................................................................................................. 7 Background ................................................................................................................................. 9 Food Security .......................................................................................................................... 9 Undernourishment................................................................................................................. 10 Overweight ............................................................................................................................ 10 Micronutrients ....................................................................................................................... 10 Global Policy ........................................................................................................................ 14 Thyroid Function .................................................................................................................. 14 Hashimoto’s Thyroiditis ....................................................................................................... 16 Risk Factors .............................................................................................................................. 17 Global Prevalence ................................................................................................................. 19 Socioeconomic Status ........................................................................................................... 20 Conceptual Framework ............................................................................................................. 21 Methods..................................................................................................................................... 22 Research Strategy .................................................................................................................. 22 Inclusion Criteria. ................................................................................................................. 22 Exclusion Criteria. ................................................................................................................ 23 Results ....................................................................................................................................... 23 Data Analysis ........................................................................................................................ 23 Limitations ............................................................................................................................ 38 Conclusion ................................................................................................................................ 38 References ................................................................................................................................. 40 IODINE AND HASHIMOTO’S THYROIDITIS 7 Introduction Food insecurity is a global health issue that affects more than 700 million people. Food availability, access, and utilization are the three factors that determine the level of security for everyone. Countries that face higher levels of food insecurity are those affected by drought, population size, war, low productivity, socioeconomic status, and disease. Malnutrition is one of the consequences of food insecurity. It occurs from a lack of specific nutrients in the diet. In 2018, there were 165 million children under the age of five that are malnourished and the health issues that come with it. Malnutrition comes in three forms: undernourishment, overweight, and micronutrient deficiencies. Micronutrients are a combination of vitamins and minerals that are necessary for the proper function of our immune system as well as the maintenance of healthy tissues. Since our bodies do not produce micronutrients, the only way to get adequate amounts is through diet as well as some supplements. Iron, vitamin A, vitamin D, folate, zinc, and iodine are some of the micronutrients that people are the most deficient in which can be due to a poor diet or limited access to healthy foods. Iodine is essential for overall health, specifically for the production of thyroid hormones: thyroxine (T4) and triiodothyronine (T3). Since the body does not produce iodine, it needs to be supplemented by food; such as dairy, fish, eggs, and seaweed. If you are iodine deficient or iodine excessive, your body can produce not enough or too much thyroid hormones which have adverse effects on the body. The thyroid, heart, liver, kidney, muscles, and the brain are all at risk for damage (Kapil, 2007). Approximately 2 billion people are suffering from Iodine Deficiency Disorders (IDD) and 50 million are dealing with the health issues related to being iodine deficient (Biban & Lichiardopol, 2017). IODINE AND HASHIMOTO’S THYROIDITIS 8 Hashimoto’s thyroiditis was first discovered by Dr. Hakaru Hashimoto as an organ- specific autoimmune disorder affecting the thyroid. This disease progresses slowly, causing chronic thyroid damage, and leads to a drop in thyroid hormone levels. In 2018, the global incidence of Hashimoto’s thyroiditis was 0.3-1.5 cases per 1000 (Lee, 2018). The Universal Salt Iodization (USI) policy was created as part of a global health initiative in 1994 to decrease the number of people that are iodine deficient (Doggui, et al., 2016). There has been a substantial decline in the amount of iodine deficient countries, however, more work should be done to have all countries covered. The globalization and population health framework are made up of the contextual, distal, and proximal levels. The levels
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